Provider Demographics
NPI:1366688822
Name:EDWARD A. FLETCHER, D.D.S., P.S.
Entity Type:Organization
Organization Name:EDWARD A. FLETCHER, D.D.S., P.S.
Other - Org Name:TUMWATER DENTAL ARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-786-9354
Mailing Address - Street 1:100 DENNIS ST SW STE G
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-786-9354
Mailing Address - Fax:360-786-8490
Practice Address - Street 1:100 DENNIS ST SW STE G
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6523
Practice Address - Country:US
Practice Address - Phone:360-786-9354
Practice Address - Fax:360-786-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4710261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1588877922OtherNPI NUMBER